This application, titled A Multifaceted Intervention to Reduce Ventilator-Associated Pneumonia in the ICU is in response to PAR-10-038_ Dissemination and Implementation Research in Health (R01) program announcement. Prevention of healthcare-associated infections (HAIs) has become a national public health priority. Ventilator-associated pneumonia (VAP) is the second most common, and the most lethal HAI. The proposed research seeks to reduce the public health burden of VAP. Numerous guidelines provide recommendations for the prevention of VAP. Despite these guidelines, many patients do not receive these recommended interventions. Our research team has previously developed and applied a multifaceted intervention that includes a novel integrated model for translating research evidence into practice and a comprehensive unit-based safety program (CUSP) to improve local safety and teamwork culture. This multifaceted intervention includes several key attributes; converting evidence into behavior specific bundles, focusing on systems of care, engagement of local interdisciplinary teams, centralized support for technical work, local adaptation of the intervention, and creating a culture of safety. The use of this intervention has been associated with substantial and sustained reductions in VAP and the third most common HAI, central line associated blood stream infections (CLABSI) in a over 100 Michigan ICUs. Our interdisciplinary team is currently leading efforts to disseminate the CUSP:CLABSI intervention in all 50 U.S. states. The approach of the proposed research will be to update our previously successful multifaceted model to reflect current recommendations for the prevention of VAP, modify this model so that it is scalable, evaluate the impact of implementation on clinical outcomes in a statewide cohort of ICUs, and evaluate contextual factors associated with successful implementation and sustainability. Successful completion of the proposed research will reduce the incidence of VAP in a large cohort of ICUs and generate a scalable model and new knowledge about can be used to disseminate the intervention nationally.